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TB Drugs & Diagnostics Shortages Reporting Form

About this Form

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When to Use This Form

Use this form to report a shortage: when your program, facility, practice, or organization is having trouble procuring a sufficient supply of a TB drug, skin test antigen solution, or blood test materials.

Use this form to report a price increase: when your organization experiences an increase in the amount charged for a TB drug, skin test antigen solution, or blood test materials.

Who Should Use This Form

Public TB programs: state, regional, county, or city

Other public and private sector organizations such as pharmacies, hospitals, clinics, private providers, schools, correctional facilities, and long-term-care facilities

Estimated Time to Complete the Form

15 minutes for the initial report

15 minutes for each update

3 Steps to Reporting

1. Gather your data.

Product and supply chain: Name of the TB drug or diagnostic Depending on the product: strength, formulation, package size If known: manufacturer and name of the organization from which you procure the product

If reporting a shortage: amount of supply left in terms of the number of doses or weeks/months of supply remaining

If reporting a price increase: price per unit before and after the increase, type of unit on which pricing is based, and (if available) invoices

Impacts of shortage/price increase (if known at this time): Depending on the product: changes to testing and treatment practices Changes to staff activities

2. Complete the initial report.

On the bottom of this page, click the Next button to start an initial report.

Follow the instructions on the form.

After submitting an initial report, you will receive a confirmation email with a hyperlink to your report data and a PDF summary of the data you entered.

3. Report updates when the issue worsens or resolves or when new impact data are available.

Click the hyperlink on your confirmation email to start an update.

Follow the instructions on the form.

After submitting an update you will receive a confirmation email with a hyperlink to your report data and a PDF summary of the data you entered.

For more information on when and how to report, please see the instructions and FAQs.

The information you provide will be shared with your state TB program, the CDC, and the FDA and will be analyzed and reported in aggregate to inform the public about access issues related to TB drugs and diagnostics.